Remarks by Gloria Steele, USAID Acting Assistant Administrator, Bureau for Global Health, at the Day of the African Child Event

Tuesday, June 16, 2009

Subject

Day of the African Child Event

I want to thank Chairman Payne for his longstanding commitment to health and recognize our distinguished guests from the African Union and the African Diplomatic Corps. Thank you for coming and for organizing this event with the Global Health Council, Save the Children, and the US Coalition for Child Survival.

Two years ago, in his talk on behalf of USAID on this same Day of the African Child, Dr. Al Bartlett made the point that there are two ways that we can move forward from this day. One option is that - as happens with so many days and declarations - we can say important things about how children are the future of Africa, about their needs and the threats to their survival and health, about what needs to be done to nurture and protect them. And then we can go back to our offices, go back to business - and budgets - as usual. After all, as he said then, it takes no resources and no effort on our part to let a baby with pneumonia or malaria die without getting treatment, to let a little girl remain undernourished, to let her mother die in childbirth, or to fail to prevent an HIV-infected mother from passing her infection on to her baby.

We can go back to business as usual. Or, we can act.

I am proud to say that USAID and the US Government have acted. And now, through the $ 63 billion Global Health Initiative recently announced by President Obama, we will accelerate our action.

So far, USAID has joined with CDC in carrying out the President's Malaria Initiative. Together we have committed over $780 million to reduce morbidity and mortality from malaria in 15 sub-Saharan countries - including both Mali and Malawi. Most of this burden falls on infants and young children.

Through PEPFAR, focused mainly in sub-Saharan Africa, we have also led efforts to expand voluntary counseling and testing of pregnant women. For those mothers who are HIV-positive, our programs provide care and treatment to improve their own health, as well as treatment to prevent transmission of HIV to their babies. Our efforts through PEPFAR have also led in expanding the focus of HIV care and treatment to HIV-infected children.

In maternal and child health, last year Congress provided USAID with a 25 percent increase in funding. In response, USAID began an agency-wide accelerated approach to increasing the survival of mothers, newborns, and young children, focusing on 30 countries with the greatest need. 17 of these 30 countries are in Africa. This initiative will scale up high impact interventions like immunization, vitamin A, treatment diarrhea and pneumonia, and breastfeeding, focusing on reaching families in their own communities.

One of the most rewarding aspects of investments in children's health - and one that I know is appreciated by our colleagues in the Congress - is that they deliver concrete, measurable results. And we are already seeing the results of these efforts in Africa.

In 2007 and 2008, the PMI supported distribution of almost 9 million insecticide-treated bednets, helping several countries including Zambia, Malawi, and Rwanda achieve bednet coverage of over 60 percent. In 2008 alone, PMI protected an estimated 25 million people - most of them children - through indoor residual spraying, and also provided more than 15 million treatments with artemesinin-based combination therapy (ACTs) to children with fever in malaria-affected areas.

Most importantly, we are beginning to see drops in infant and child mortality in PMI countries. Our Demographic and Health Surveys in Rwanda, Zambia, and Senegal have found substantial declines in mortality of children under age five associated with PMI activities. For example, following the introduction of the PMI, Senegal achieved a drop in under-five mortality of 30 percent in just the three years between 2005 and 2008.

For children in Africa affected by HIV and AIDS, there is also progress. WHO recently estimated that in 2007, more than one-third of all HIV-positive pregnant women in sub-Saharan Africa received treatment to prevent mother-to-child transmission. This is still not enough, but it represents a quadrupling of PMTCT coverage since 2003. If this trend continues, half or more of HIV-infected women will get PMTCT services in 2009, protecting tens of thousands of infants from being born with HIV. WHO also reported last year that the number of HIV-infected children in sub-Saharan Africa who received anti-retroviral treatment tripled, to over 150 thousand. U.S. efforts have made major contributions to this progress, and also to the care of the unfortunate children who have lost one or more parents to AIDS. Last year, PEPFAR supported services for almost 4 million orphans and vulnerable children across 20 Africa countries.

Our sustained assistance to Child Survival programs in Africa - which has been accelerated through Congress's increased support - is also contributing to real progress. DPT 3 coverage across Africa has been sustained at 82% for two consecutive years. Almost three-fourths of children in Africa are receiving two doses of vitamin A. This progress has even reached some countries facing difficult challenges. In DR Congo - where no survey since the fall of the Mobuto government had found a rate of under-five mortality below 200 per 1,000 live births - the Demographic and Health ["DHS"] Survey results of last year found the rate to be 148, a more than 25 percent decline. And preliminary DHS results officially released just last week in Abuja found that under-five mortality in Nigeria has dropped from 201 per 1,000 in 2003, to 157 in 2008 - a drop of 22 per cent in just five years in a country where a million children under five have been dying every year.

These encouraging results tell us two things about saving and nurturing Africa's children. They tell us that we know how to make a difference. And they tell us that we are still a long way from making all the difference that needs to be made.

That is the importance of President Obama's announcement of the Global Health Initiative. He has recognized and maintained the important commitment we have made in dealing with AIDS and malaria, both major health threats to Africa's children. At the same time, he has committed to substantially increasing our efforts to save the lives of more children and mothers. The Global Health Initiative also commits us to accelerating progress by connecting our work on high impact health programs, through a comprehensive integrated approach that will help countries strengthen their health systems. This approach will extend even beyond health services, to harness the contributions of our investments in water and sanitation, in agriculture and food security, and in girls' education, among others, to achieve better health for families and children. Again, a major part of this commitment will be to the countries and families of Africa.

Strengthening health systems and integrating health services sounds a long way from children. But they are what countries need to deliver and sustain improved health for those children and their families.

We know that there are more challenges to face in Africa. We know that too many mothers and children are still dying preventable deaths. We know that the global economic crisis will require finding ways to reach newly vulnerable groups, like those living in urban areas. We know that children living in the face of conflict - many of whom are in Africa - will continue to have the highest risk and the greatest need.

But we also know that - with the support of the Administration and of Congress - we can face these challenges. We have done so successfully during more than two decades of U.S. support for maternal and child health. Today we are releasing a report that documents the progress made during those more than two decades… a brief history of USAID's contribution to a global partnership with other donors, NGOs, the private sector, the U.N., and especially countries themselves. That collaboration has resulted in a reducing the number of deaths of children under five from over 15 million in the 1980s to an estimated 9.2 million in 2008. This adds up to saving 6 to 7 million child lives each year. U.S. resources and leadership have played a major role in this incredible success.

The President's Global Health Initiative reaffirms this commitment of resources and leadership, and takes it to a new level. We welcome this commitment. We at USAID are ready to bring our abilities, our hard work, and our experience to bear in partnership with all of you and our country partners in Africa, to continue improving the survival and health of Africa's children.